Purpose. Transversus abdominis plane (TAP) blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20？mL bupivacaine 2.5？mg/mL with epinephrine 5？μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36？hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10) at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36？hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48)？mg (median, IQR) within the first 48？postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery. 1. Introduction Epidural analgesia is commonly used for the treatment of postoperative pain after major abdominal surgery despite the well-known risks and the long list of contraindications [1, 2]. During the last few years, interest has grown concerning the use of transversus abdominis plane (TAP) block as an alternative to epidural analgesia. A TAP block provides analgesia of the anterolateral abdominal wall through blockade of the lateral and anterior cutaneous branches of Th7 to L1 as shown in volunteers by McDonnell et al. [3]. Clinical trials have shown that a bilateral single-shot TAP block reduces pain after large bowel resection and total abdominal hysterectomy [4, 5]. The duration of a single-shot TAP block is limited by the pharmacokinetics of the local anesthetic used, and therefore, the use of TAP catheters has been described in order to prolong the effect of the TAP block through infusion or injection of local anesthetic [6–10]. Only two prospective, randomized studies have been carried out [11, 12]. Kadam and Field [11] randomized 40 patients undergoing non-specified major abdominal surgery to receive either a single-shot TAP block at the end of surgery followed by a 72？hr infusion at 8–10？mL/hr of 0.2% ropivacaine 2？mg/mL and fentanyl
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